Download The University of Chicago Medicine

The University of Chicago
Medicine:
Driving Engagement With
Interactive Care
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 Training front-line clinical and administrative staff to encourage patients
to use technology, but also reminding them of the importance of
human-centered, face-to-face care.
 Implementing a mobile platform that allows caregivers to record health
information and to connect with providers as needed to track treatment
plan adherence, preventative care efforts, and disease management.
 The importance of validation of technology support and facilitated by
leadership.
 Reminders, motivational messages, and education tips to patients
through this platform.
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The University of Chicago Medicine & Biological Sciences
 Embedded in the University of
Chicago campus in Chicago’s
Hyde Park neighborhood
 More than a century of
groundbreaking research and
innovation
 University of Chicago Biological
Sciences
– 800+ faculty; among top 5
U.S. medical schools for
generating federal dollars
per faculty
 Pritzker School of Medicine
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University
of Chicago Medicine
Center for Care and Discovery, Bernard A. Mitchell Hospital, Comer
Children’s Hospital and Duchossois Center for Advanced Medicine
– 22K Admissions
– 385k diagnostic and
outpatient treatment visits
– 75K ED visits
– 30K PED visits
– 9,500 employees
– 900+ Physicians
– 1,500+ Nurses
– 900 Residents/fellows
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UCM Mission
Our mission is to provide superior health care in a
compassionate manner, ever mindful of each patient’s dignity
and individuality.
PRIDE Values
Participation
Respect
Integrity
Diversity
Excellence
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Patient Experience and Engagement Program
 Nurse/ Physician Executive Leadership team
 Experience and Engagement strategic planning and implementation
 Analytics
 Patient Insights
 High touch services
 Technology Enablers
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FY 2015 Goals
 Deliver a consistent patient experience across all four UCM platforms of care
 Create lasting market differentiation and loyalty through innovation and
consistent performance
 Develop a continuous improvement model that infuses the voice of patients,
families, employees, and physicians
 Unify quality, safety, efficiency, and experience strategies to improve
satisfaction and outcomes
 Incite change by creating and celebrating memorable moments
Quality
Safety
Experience
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Set Experience Strategy – Patient Experience
Annual Operating Report
Work streams
Objectives
Business
Optimization
Growth and New
Payment Models
• Throughput and
Asset Productivity
• Ambulatory
Operations
• Improve Margin
Position
• Clinical Service
Line Business
Planning
• Value Based
Payment
• Population Health
Management
Care Delivery
Transformation
• High Reliability
Organization
• Care Model
Redesign
• Clinician
Accountability
Service
• Patient-Centered
Care
• PRIDE value focused
Environment
• Patient Engagement
and Empowerment
Foundational Elements
(Human Capital Plan, Master Space Plan, Lean Deployment Plan, IS Plan, EIA)
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UCM Interactive Patient Care Vision
We will provide an unparalleled, truly
interactive patient care experience where
the patient and family are active, engaged
and empowered participants in the care
process.
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Technology Platform Assessment
 Interactive Patient Care (via GetWell Network)
– ED Videos
– PxP
 Discharge Recorded Messages
– Unit
– Patient Population
 Diabetes
 COPD
 Heart Failure
 MyChart
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Interactive Patient Care (IPC)
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Why Interactive Patient Care (IPC)?

IPC provides a more personalized care environment for patients
and their families

IPC supports clinicians with a consistent approach for providing
patient education that increases patient engagement

Engaging patients to play a more active role in their
healthcare…
– Improves the patient experience (patient satisfaction)
– Enhances patient safety and improves quality
– Improves hospital performance
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Fundamentals and Requirements
Utilization is key to realizing the impact
Requires strong nursing adoption and
integration into the clinical practice
Must be hardwired into care-giver role
Important to design and configure the tools for seamless
integration and flow into daily practice
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Road Map To Success
Engage Hospital Leadership:
–
Manage change, motivate staff and generate results
 Care Process Integration:
–
Implement best practice workflows for improved outcomes
 Empowers Clinicians and Staff:
–
Train the staff support their pursuit of success
 Deliver World Class Service:
–
Support every caregiver, every patient,
every hour, every day
Interactive patient care (IPC):
A new and innovative care delivery model for today’s
interdisciplinary care team!
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Clinical Practice Design Process
PROCESS OBJECTIVES:
 Hardwire Interactive Patient Care (IPC)
as a new care delivery model
 Create organizational context with a
vision and impact expectations for IPC
 Use performance improvement targets to
inform the patient care practice areas to
focus on
 A multidisciplinary group to evaluate and
redesign core nursing practices to realize
IPC Vision and increase nursing adoption
 Apply the technology to help support that
newly defined practice standard
IPC Vision and Strategy
Priority Focus Areas
Current Practice Audit
Clinical Workflow Design
Configuration of Tools
Change Management
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Get Well Network
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Education Videos
 There are 3 Patient Education Pathways
– Fall Prevention
– Pain Management
– Discharge Planning
 Video education is the main component for each pathway
– Clinician orders education via Epic
– Patient receives education via GetWellNetwork
 Additional patient interactions on GetWellNetwork
– Fall Prevention Alert (every 2 hrs for 15 secs) –
Call, Do Not Fall
• Only high risk patients receive this alert
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Fall Prevention Pathway with Interface
Education ordered
Order Status to
“In Process”
HL7HL7
Order
Document to Result
Review
HL7HL7
Order
Dat
Event
a
HL7HL7
Order
Dat
Event
a
Dat
Event
a
Fall Prevention
Education
Pathway
HL7 Result
Education
Complete
Patient is prompted to complete education
? ?
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GetWellNetwork High Risk Falls Alert
Senior User
Experience
Adult Experience
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Day Prior to Discharge Prompt
Nurse activated following multidisciplinary rounds
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Discharge Management
Countdown to Discharge Pathway
Discharge Readiness Questions 3
1
2
1.
Question 1: Do you have someone to help you at home?
2.
Question 2: Do you have someone to give you a ride from
the hospital to your home or care facility?
3.
Question 3: Do you have any questions about
medications?
4.
Question 4: Do you have any other questions about your
condition?
5.
Question 5: Do you know when your follow up
appointment is?
6.
Question 6: Is there anything that would prevent you from
going home on discharge date?
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Pain Acknowledgement Pathway
Goal:
 Continuity in patient family education regarding pain
management
 Patient “acknowledgement” of their role in pain management
process
 Expectation setting around pain management process
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Patient Experience Perception (PxP)
 Patients receive survey questions on GetWell Network
– 1 survey (3 questions) at 1 PM CT (Monday-Friday)
 Every other day (starting day 2 after
admission, ending on day 10)
– 1 survey question at 10 PM CT (Monday-Friday)
 Every day
 Provides the ability to monitor patient satisfaction in real
time
– Address patient feedback and provide service
recovery
 Identify trends and utilize patient feedback to improve
the patient experience at University of Chicago Medicine
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Questions asked of Patients via PxP
 Is the staff answering the call light?
(Yes, I Don’t Know, No)
 How is the hospital staff doing controlling your pain? (Great,
Ok, Not Good)
 Is the noise outside your room keeping you awake at night?
(Yes, I Don’t Know, No)
 Have your nurses listened and explained things to you? (Yes,
I Don’t Know, No)
 ( PICU Only)Have your doctors listened and explained things
to you? (Yes, I Don’t Know, No)
 (NICU Only) Is the hospital staff teaching you about your
medications and the side effects? (Yes, I Don’t Know, No)
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Staff Experience – Notifications and Scorecard
 If the patient/ family selects the negative response (Not Good/ No) a
notification is sent for follow up to:
- The Nurse Manager and Charge Nurse
- The Patient Relations team
 All patient responses are tracked and trended in the PxP scorecard on
the Management Console for GetWell Network
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Utilization for Key Focus Areas (CCD)
Service Utilization
Overall Utilization
99% 100% 97%
100%
80%
91% 95% 92%
100%
80%
67%
Baseline
60%
All Units
40%
10 East
20%
10 West
0%
Baseline
60%
40%
20%
All Units
10 West
0%
Overall
Overall
Safety Utilization
Health Utilization
25%
25%
20%
13%
15%
10%
5%
10 East
19%
6%
1%
Baseline
11%
All Units
10 East
10 West
0%
20%
16%
15%
11%
10%
5%
6%
Baseline
All Units
10 East
10 West
1%
0%
Overall
Overall
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myGetWellNetwork Interactive Pathways
Patient Pathways
 Daily touch-points with patient before and after hospital visit (proven to
improve patient outcomes)
 Available from a variety of web-enabled devices.
 Reduce 30 day readmissions diagnoses (AMI, Heart Failure, Pneumonia)
and chronic disease management (Asthma, Diabetes, COPD)
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Daily engagement to keep on track
Patient Pathways
Pathway focuses on 30-days post discharge
Day 30
Day 14
Day 1
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Get Well. Anywhere.
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Vocera Good to Go - Update
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Vocera Good to Go - Update
9 west
- Currently used for patients.
ACTIONS
- Continuing support to
department to increase the
number of patients whose
discharge instructions are being
recorded.
- Provide monthly management
information
- Conduct staff walkthroughs
Diabetes Nurse Educators
Identify other departments
- Highly motivated to use tool.
- Department wishes to have an
educational library installed in Vocera
prior to start using tool.
CONCERNS: the department would like to
use videos that are currently being offered
in Get Well Network. It’s unclear if UCM is
allowed to use these videos in Vocera, and
/or if it’s technically possible to use these
videos.
- Cardiology (5SW)
- Interested in using tool.
- Potential other departments:
- COPD / Asthma
- Transplants
ACTIONS:
- support department in building
educational library.
- exploring other sources of information
than GWN to build library.
- Exploring options to use tool prior to
library being ready.
- Working with GWN and Kari Petzold on
finding solution for use of GWN videos.
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MyChart
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Patient Portal Enrollment
 Easily enroll patients in your portal while in hospital.
 Drives patient portal utilization.
 Fits easily into the discharge planning process.
1
2
3
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Validation of Patient Center Technology
 Nurse Leader Rounding
 Discharge Care Center Calls
 Quarterly Outcome Patient Experience Results (Press
Ganey)
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Leader Rounding
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Leader Rounding: Approach

Challenges
– Lack of structured rounding
– Lack of clarity on standard practice
– Needed to streamline accountability
– Limited ability to capture patient complaints or compliments
– Unable to track or address trends

Solutions
– Standardize rounding with iPad technology
– Create alert process for support departments
– Capture, act on complaints and compliments in real time
– Outline expectations and ensure accountability
– Report rounding trends
– Reward and recognize staff
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Leader Rounding: Approach
 Identified 29 Units
 Conducted leader education
on tactics and importance of
rounding
 Engaged frontline staff and
leaders to design proper
rounding process
Adult Inpatient
Pediatric Inpatient
Adult Emergency Department
Pediatric Emergency
Department
• NICU
• PICU
• Child Life
•
•
•
•
 Implemented Care Rounds technology to streamline,
standardize, and track real-time rounding using an iPad
 Took action and rewarded leadership and
staff immediately for wins
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Leader Rounds: November 1, 2013 – December 31, 2014
 32 units practicing leader rounding
 Total Rounds: 40,945
 Leader Rounds with Positive Rating: 25,479 (62%)
 Staff Recognitions: 9,324
 Follow-up Requests: 1,203
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Leader Rounding: Transparency and Accountability
Collect - Analyze – Share – Learn - Act
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Leader Rounding
 Engage and excite leadership by explaining potential for
standardizing and tracking meaningful rounds
 Educate and involve frontline staff early in the training and
development process
 Create a culture for cross-departmental coordination
 Reward and recognize employees throughout new process
training
 Consistently track, report, act and improve
 Hardwire experience improvement strategies with
technology
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Rounding Effectiveness: Nurse Manager Check
Overall Rating of Care
96.0
94.0
92.0
Mean Score
90.0
12.4 Mean
Score Point
Difference
88.0
86.0
84.0
n= 1997
82.0
80.0
78.0
n= 581
76.0
74.0
Nurse Manager Check on you Daily- No
Mean Score- 81.0
Nurse Manager Check on you Daily- Yes
Mean Score- 93.4
© 2015 Press Ganey Associates, Inc.
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Discharge Care Call Center
 Goals: Elevate service to reduce readmission rates
– Extension of the service team and caring to home
– Coordinate feedback related to service experience
 Functions:
– Call DCAM and CCD ambulatory surgery patients post
discharge to home
– Calls places within 3 to 5 business days post discharge,
unless otherwise notified
– Forward compliments and complaints to management and
Patient & Family Insights team
– Practice service recovery for patients and families
– Confirm post op and additional follow-up appointments
– Connect patients with specific clinical services for follow-up
– Coordinate with clinical services on follow-up calls and
clinical issues
– Support a smooth transition for patients and families that
extends to the home
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Patient Feedback Discharge Calls
Service
Comment
Inpatient
People who served food as well as those who answered phones and took orders were extremely courteous.
Inpatient
This was the best hospital experience of my life largely due to the work and attitude of my nurses. They were, without
exception, wonderful.
Inpatient
Nurse Cathy was wonderful - very caring and gave me all the information I needed to care for myself at home.
Outpatient Oncology
Each & every time we needed to call WE WERE ABLE TO REACH them or they would call back in 10 min. One time,
wonderful Dr. Hahn actually answered the call herself. If not, Tara would call back in 10 mins, Johanna too.
Outpatient Oncology
They always let us know what's going on and how long to hook up. Very considerate. If my shoulder shows they
close the drape.
Outpatient Services
My medical practitioners, assistants & staff address not only immediate concerns, but exhibit extreme patience when I
have questions in reference to complete care & options, by providing me with as much time needed. Their undivided
attention is given to me prior to my discharge...to contribute to "calm departure".
Outpatient Services
Over the phone communication was excellent (Chris was very informative, courteous, and professional, felt
comfortable with his instructions.
Inpatient Pediatric
Informative. Nurse service was excellent start to end.
Inpatient Pediatric
Everyone from registration, to doctors and nurses were extremely informative & super friendly!
Emergency Department
Talked me through every step that was going on, the medicine that was administered and the way it will help.
Emergency Department
Reg[istration] staff was very courteous and professional.
© 2015 Press Ganey Associates, Inc.
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Outcome Data/Press Ganey HCHAPS
HCHAPS
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Future Initiatives
 Kiosks – Real Time Patient Feedback
 Ambulatory Care – Pre-Post Visit Rounds
 Think Tank Group (IPC)
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Lessons Learned Overall
 Review technology for your culture
 Leadership/Front line staff from beginning
 Build training into NEO for all resources
 Lots of data from all over – manage data
 Consider starting on units where buy-in is present
 Share success stories – the why behind
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Debra Albert, RN MSN MBA NEA-BC
Senior Vice President, Patient Care Services
Sue Murphy, RN BSN MS
Executive Director of Patient Engagement and
Experience
The University of Chicago Medicine
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